Reducing Opioid Exposure in a Level IV Neonatal Intensive Care Unit. Issue 4 (July 2020)

• Record Type: Journal Article
• Authors: Stetson, Raymond C.; Smith, Brandi N.; Sanders, Nicole L.; Misgen, Megan A.; Ferrie, LaRae J.; Schuning, Virginia S.; Schuh, Allison R.; Fang, Jennifer L.; Brumbaugh, Jane E.
• Is Part Of: Pediatric quality & safety. Volume 5:Issue 4(2020)
• Publication Date: 2020-07
• Subjects: Pediatric nursing -- Periodicals; Pediatrics -- Periodicals; Patients -- Safety measures -- Periodicals; Children -- Hospital care -- Periodicals; 618.92
• DOI: 10.1097/pq9.0000000000000312
• Languages: English
• ISSNs: 2472-0054

Abstract

Abstract : Introduction: Infants in neonatal intensive care units require painful and noxious stimuli as part of their care. Judicious use of analgesic medications, including opioids, is necessary. However, these medications have long- and short-term side effects, including potential neurotoxicity. This quality improvement project's primary aim was to decrease opioid exposure by 33% in the first 14 days of life for infants less than 1, 250 g at birth within 12 months. Methods: A multidisciplinary care team used Define, Measure, Analyze, Improve, Control methodology to identify root causes of the quality gap including: (1) inconsistent reporting of objective pain scales; (2) variable provider prescribing patterns; and (3) variable provider bedside assessment of pain. These root causes were addressed by two interventions: (1) standardized reporting of the premature infant pain profile scores and (2) implementation of an analgesia management pathway. Results: Mean opioid exposure, measured in morphine equivalents, in infants less than 1, 250 g at birth during their first 14 days of life decreased from 0.64 mg/kg/d (95% confidence interval 0.41–0.87) at baseline to 0.08 mg/kg/d (95% confidence interval 0.03–0.13) during the postintervention period ( P < 0.001). There was no statistical difference in rates of days to full feedings, unintentional extubations, or central line removals between epochs. Conclusions: Following the implementation of consistent pain score reporting and an analgesia management pathway, opioid exposure in the first 14 days of life for infants less than 1, 250 g was significantly reduced by 88%, exceeding the project aim. Abstract : Supplemental Digital Content is available in the text.